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GI Questions 2Smeltzer (Med-Surg)

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Kyle Y. will be going to get a sigmoid colostomy tomorrow morning. He is concerned and asks you what his "elimination" will be like when he receive this. What should you say?
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By post-op day 4/5, there will be semi-formed stool with a small/mod amount of mucus. After several weeks, the output will routinely resemble semi-formed stool. Kyle can expect to resume a similar pre-op pattern.
You see in a patient's chart he is scheduled for a transverse colostomy. How many days post-op do you expect it to take for him to pass stool? And what kind?
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Approximately 2-3 days PostOp, for small semi-liquid with some mucus. *Blood may be present first couple days* Eventually it will turn to become more stool-like. He should be able to eventually resume a normal pre-Op pattern.
Is it normal to expect normal urine output with some mucus and blood following a urostomy?
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Yes.
In some urostomies, an artificial bladder can be made from the large intestine. In this case, what kind of output should the nurse expect?
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Less, because more water will be absorbed.
The patient of yours who just had a urostomy says, "I know a friend who has a colostomy. She only goes once or twice a day. Is that what I'll do?" You reply...
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No, your output will be continuous.
A priority intervention for those patients who have a higher ostomy is?
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Skin integrity. The higher up an ostomy the more liquid and acid the output will be.
Ostomy teaching incorporates education about when to change the bag. In general, patients should change their bag when...
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it's 1/4-1/2 full
Rachel, your 45 year old patient who just received a colostomy, asks you to explain her new diet regimen. You discuss the following guidelines:
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- Avoid odor foods: fish, eggs, asparagus, garlic, beans, dark green leafy veggies - Gas foods: dark green leafy veggies, beer, carbonation, dairy, and corn - Avoid high fiber for first 2 months --> chew food well, plenty of liquids
Breaking down the PLISSIT model...
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P: permission to discuss Limited Info: tailored discussion. Not overwhelm Specific Suggestion: address their concern! Intensive Therapy: refer as needed
Candy remembers learning how healthy stomas should be beefy, pink/red, and moist. While examining her patient's stoma, she notes it to be pale pink/blueish/purple. She immediately knows to notify the provider the stoma is...?
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Ischemic. If the stoma appeared black or definitely purple, this is BAD - Stat VS, POX, labs!
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Intestinal obstruction can occur for numerous reasons. The nurse should assess for what indicators of an obstruction?
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Abd pain, hypoactive/absent bowel sounds, distention, N/V. Report!
With ostomies, if the patient's BP drops, HR increases, and has a decreased urine output, the nurse should consider what problem?
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Probably initially F/E imbalance. Get VS and lab data. Also could be bleeding.
Paracentesis removes ascitic fluid for diagnostic purposes or to relieve...?
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Abd pressure. Dx intra-abd bleeding, INFx, or pancreatitis.
What is the overall factor in the use of paracentesis and its evaluation?
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RR distress*
In ascites, the PRO leaves the blood to go into the interstitial spaces. What will this cause?
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Hypovolemia. *This shift is the major fact in determining how much fluid can safely be removed*
Baseline _____ and _____ MUST be measured before a paracentesis. Then gather equipment, and as always, must check what paper work?
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Weight and abd circumference. Always check the consent has been signed.
Lindsey, the clinical nurse specialist, is preceptoring a nursing student. Lindsey instructs the student to complete what GU intervention prior to the paracentesis?
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Get the patient to void or insert Folely.
T/F: Conscious sedation is used for a paracentesis?
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False: local anesthesia
Like with a thoracentesis, explain to the patient they may feel pressure or pain. This corresponds to the first post-intervention, which is?
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Pressure on insertion site for several minutes!
Lindsey also instructs her nursing student to obtain what information so a comparison can be made?
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Post-procedure vitals, weight, and abd circumference.
There is always a risk for INFx when outside materials are introduced to the body cavity. Thus every 4 hours for 48 hours, the nurse must assess..?
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Temperature
  
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